06 July 2012 1:31 PM

Too many hospitals and not enough people willing to say so

A mother told the story on the radio yesterday of her infant son’s time in Leeds Hospital and the strain it had put on her family despite being local. He survived, but Leeds is one of the hospitals that is losing is children’s heart unit because it doesn’t see enough patients to be considered safe. This is a cautionary tale, because England has too many hospitals altogether, and for reasons of safety and financial sustainability we are all going to have to get used to going to hospital less but traveling further when we do. The trouble is, many have known this for decades yet gone on pouring money into NHS hospitals.

Although there was good news out yesterday in that 377 NHS organisations are not over-spending tax-payers money and are in the black, the bad news was that 34 NHS organisations are in the red and of these, 31 are hospitals. In other words, 31 hospitals are overspending and this is to the tune of £356 million. This is slightly less than 8% of all hospitals, but digging a little deeper into the NAO report on 'Securing the future financial stability of the NHS' showed that 51 more NHS organisations (another 12%) were only just in the black and that many of them had received extra money during the year in order to keep them solvent having blown their original budget.

PFI - Private Finance Initiatives - are in the frame as one of causes of hospital debts. Introduced to the world by Norman Lamont in 1992 they were formalised by Labour with their formation of Partnerships 2000, a PFI management body. Essentially PFI offers the chance for a hospital to take on a mortgage to support a redevelopment or expansion of their buildings. The private sector was already building most public facilities but the PFI also enabled the design, financing and operation of the new build to be carried out by the private sector as well as taking on some or all of the associated risks. PFI provided the large sums of money required to redevelop a hospital without increasing public debt - more so because PFI liabilities were controversially kept off all departmental balance sheets, thus enabling the Department of Health to circumvent their departmental spending limit. It was the only show in town if you were a hospital chief exec wanting to expand your domain, but many hospitals now basically have a credit card bill that they are struggling to pay.

We already knew back in the 90's and even more so in the noughties that we could not go on doing what the now chief exec of the NHS, Sir David Nicholson, calls 'business as usual'. Hospitals are expensive to run and much of what happens in hospital can take place in the community or even the home. There is nothing intrinsically wrong with PFI but since the first PFI hospital was opened by Tony Blair in April 2000, another 104 PFI deals have been signed off by the Department of Health. What were they thinking? We already had too many hospitals - and some of them are now saddled with debts that consume 10% of their annual budget and empty floors they can't fill. Who were the lawyers that drew up such punitive contracts? Who were the civil servants who merrily maxed out the NHS credit card? Where was the strategic plan that guided hospital expansion? Who was thinking about sustainability in a sector where up to 70% of funding goes on wages? Where is the accountability?

Not only do we now have a debt mountain but we still have too many hospitals, too many beds, too many clinicians doing things as they always have. PFI has in some cases made the situation worse with certain hospitals too large, too costly and with too much capacity. With the exception of the children’s heart units - which took over ten years from recommendation of closure to the decision being taken yesterday - there is still the sound of silence when it comes to any communication with the public that radical transformation (i.e. hospital closure) has to take place to keep the NHS safe and affordable. This children's heart unit decision could be the start of a new, honest dialogue with the public – we’ll see if the opportunity is taken.

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JULIA MANNING

Julia studied visual science at City University and became a member of the College of Optometrists in 1991. Her career has included being a visiting lecturer in at City University, visiting clinician at the Royal Free Hospital, working with Primary Care Trusts and a Director of the UK Institute of Optometry. She also specialised in diabetes and founded Julia Manning Eyecare, a practice for people with mental and physical disabilities. In 2006 she established 2020health.org, an independent Think Tank for Health and Technology. Research publications have covered public health, telehealth, workability, pricing of medicines, biotechology, NHS reform and fraud.